A retrospective review and comparison of leak rates and bleeding complications between open, laparoscopic and robot assisted rny gastric bypass procedures. a single surgeon experience over 16 years

Background

The objective of this study is to evaluate and compare postoperative major complications in the first 30 days including leaks and bleedings after RNY gastric bypass procedures (RNY) performed using open (Open), laparoscopic (lap.) and Da Vinci robot assisted (Da Vinci) approaches performed by a single surgeon over a period of 16 years.

Methods

A prospective database (Lapbase ®) has been maintained on all patients undergoing bariatric surgeries by the author. This review covers all RNY surgeries performed by the author between July 2000 and Sep. 2016. Most RNY procedures were performed using Open technique between July. 2000 and Sep. 2004. After that most RNY procedures were performed using Lap. technique till Jan. 2006. Most RNY procedures were performed using Da Vinci since 2006. Open RNY procedures involved the use of a circular stapler. Lap RNY procedures involved using 25 mm of a 30 mm long linear stapler for gastrojejunostomy and Da Vinci procedures involved creation of handsewn gastrojejunostomy around 36 Fr. orogastric tube. Jejuno-jejunostomy technique was similar for all 3 approaches.

Results

A total of 1786 primary bariatric procedures were performed during this period. 1496 patients (84%) were females and 290 (16%) were males. There were 803 RNY procedures, 416 sleeve gastrectomies and 567 lapband procedures. Among RNY procedures, (n=803), there were 105 Open, 495 Lap. and 197 Da Vinci procedures. There were 6 conversions from Lap. to Open. None of the Da Vinci procedures needed a conversion. Among the Open procedures (n=105), there were 9(8.5%) leaks, out of which 2(1.9%) required reoperation. There were 5 (4.7%) postop bleedings, out of which 3 (2.8%) required blood transfusions. Among lap. RNY procedures (n=495), there were 7(1.41%) leaks, out of which 2 (0.4%) required reoperation and 1(0.2%) bleeding that needed blood transfusion. Among Da Vinci procedures (n=197), there were 3(1.5%) leaks, out of which 2 (1.0%) needed reoperations and there were no bleedings requiring blood transfusions. All 3 leaks after Da Vinci RNY procedures were encountered in the first 35 cases. Differences were statistically significant when Lap. or Da Vinci groups were compared to Open but not significant when Lap. compared with Da Vinci group.

Conclusions

This review of a nonrandomized prospectively collected data shows a lower incidence of leaks and bleedings after lap. and Da Vinci RNY procedures compared to open technique but no significant difference between Lap. and Da Vinci procedures.